Background: Geographic hospitalist staffing and interdisciplinary rounding has been shown to improve staff communication, patient communication, and reduce length of stay. Communication between hospitalist and nurses also play a crucial role in patient safety and hospital throughput. Despite its importance, maintaining geography is difficult and communication between physicians and nurses are often sub-optimal and fragmented.
Purpose: We created an enhanced geographic rounding model between hospitalists and nurses for a quality improvement project, and looked at its effect on throughput, staff communication, and staff satisfaction.
Description: We implemented the project on a non-teaching 30 bed medicine unit in a large urban medical center. Prior to implementation, the unit was staffed daily by 2 hospitalists (out of a pool of 23) and 6 nurses. Nurses were divided among the unit geographically, but hospitalists followed patients throughout the unit. Hospitalists therefore could work with up to six nurses on any given day to provide patient care. Starting in June 2018, the unit was divided into 2 wings, each staffed by a permanent pair of hospitalists (alternating 7 on/7 off) and three nurses. Based on this new geographical model, patients located in each wing were cared for by a core team of one hospitalist and three nurses. In August 2018, we added clinical rounding, where hospitalist and nursing teams rounded on all patients on their wing to discuss key patient issues, treatment goals, nursing concerns, and discharge needs. These rounds occurred away from patient rooms where medical jargon between providers can be freely used. Initially, we faced many difficulties in maintaining enhanced geography, obtaining staff buy in, and timing rounds to avoid negatively impacting workflow. However, with increased involvement by the hospital logistics team for bed assignments as well as hospitalist oversight, enhanced geography was maintained between an estimated 70 to 100% of the time. The most common cause for a break in enhanced geography was a change in patient room assignments from one wing to another during their hospital course due to contact needs. At the beginning of the project, clinical rounds occurred a measured 50% of the time, but this improved to 100% after staff education and buy in. To evaluate the project, we monitored and saw an improvement in average monthly discharges from 168.2 patients (average of the 5 months prior to project initiation) to 193.4 patients (five months after project) , as well as a positive trend in the number of positive responses on nursing surveys on areas involving patient communication, staff communication, and staff satisfaction.
Conclusions: There were barriers to creating enhanced geographic rounding, but geographic rounding between hospitalist and nurses on our unit has improved team work and collaboration between physicians and nursing, which has helped with staff satisfaction and patient communication.